Propylthiouracil-induced lupus-like or vasculitis syndrome

Area of Science:

• Internal Medicine
• Rheumatology
• Pulmonology

Background:

• Graves' disease management involves medications like propylthiouracil (PTU).
• PTU is known to have potential side effects, including autoimmune reactions.
• Distinguishing between drug-induced lupus and vasculitis can be challenging.

Purpose of the Study:

• To report a case of propylthiouracil (PTU)-induced autoimmune disease.
• To highlight the diagnostic challenges in differentiating drug-induced lupus (DIL) from vasculitis.
• To emphasize the importance of medication review in complex autoimmune presentations.

Main Methods:

• Case report of a 27-year-old female with Graves' disease on irregular PTU use.
• Clinical presentation including fever, dyspnea, polyarthralgia, erythema nodosum, neutropenia, and hematuria.
• Diagnostic workup included imaging (Chest X-ray, CT), bronchoalveolar lavage (BAL), and serological tests (ANA, ANCA panel).

Main Results:

• Patient presented with symptoms suggestive of systemic autoimmune disease.
• Imaging revealed pulmonary opacities, pleural effusion, and pericardial effusion.
• Serology was positive for ANA, P-ANCA, MPO-ANCA, and PR3-ANCA.
• Symptoms resolved upon PTU withdrawal and steroid initiation, recurring upon PTU re-exposure.

Conclusions:

• Propylthiouracil (PTU) can induce a complex autoimmune syndrome with overlapping features of DIL and vasculitis.
• Accurate diagnosis requires careful consideration of medication history and clinical-diagnostic correlation.
• Prompt recognition and management, including drug cessation, are crucial for patient recovery.